Rehabilitation of quadriparesis secondary to spinal cord sarcoidosis

Sarcoidosis is a multisystem granulomatous disorder that rarely involves the spinal cord. This report describes the presentation and rehabilitative course of a 31-yr-old man with quadriparesis secondary to spinal cord sarcoidosis. The patient had insidious, progressive weakness in his arms and legs for six weeks before evaluation. Examination revealed a C4 incomplete spinal cord injury. Computed tomography demonstrated an intrinsic cord lesion from the brainstem to approximately T8. Magnetic resonance imaging (MRI) suggested the lesion was granulomatous and cervical laminectomy confirmed noncaseating granulomas. The patient was started on high dose steroids, subsequently gained strength in the distal upper extremities, and was sent for spinal cord rehabilitation. Examination revealed 3 to 4+/5 strength in the upper extremities, 2- to 3-/5 in the lower extremities. The right side was slightly stronger than the left, with proximal musculature stronger than distal. Sensory examination was intact except in the C-8 to T-2 dermatomes. The patient was dependent in self-care and mobility except for feeding. Initial progress was inhibited by severe spasticity requiring medication, but by discharge he was independent at the wheelchair level with 4/5 strength in all four extremities except for his hands, which had 3/5 strength. Sensory exam did not change. Follow-up MRI studies revealed reduction of the lesion. Review of previous cases revealed that myelopathy is the most common presenting complaint and cervical segments are most commonly involved. Survival averaged almost three years and significant gains were made in functional status. Rehabilitative course and special considerations, treatment and follow-up recommendations are discussed.